Term
| ______ are first line for mild to moderate migraines |
|
Definition
|
|
Term
| For Migraines, the Anaglesics used are_____ |
|
Definition
| Acetaminophen (tylenol), acetaminophen/aspirin/caffeine (excedrin), acetaminophen/butalibital/caffeine (Fioricet), Aspirin/butalbital/caffeine (Fiorinal), Isomethptene/dichloralphenazone/acetaminophen (midrin) |
|
|
Term
| Analgesics containing ____ may cause overuse headaches and withdrawal. |
|
Definition
| Butalibital (Fioricet and Fiorinal) |
|
|
Term
| Acetaminophen, by itself, is (not recommended/recommended) for migraines |
|
Definition
| not generally recommended |
|
|
Term
| Excedrin (Caffeine/acetaminophen/aspirin) is (proven/not proven) in effectiveness |
|
Definition
|
|
Term
| The NSAIDs used for migraines are ________ |
|
Definition
| aspirin ibuprofen, naproxen, diclofenac |
|
|
Term
| NSAIDs with (long/short) half lives are preferred |
|
Definition
|
|
Term
| With analgesics, ______ increase(s) the risk of med-overuse headaches |
|
Definition
|
|
Term
| ______ should be used with care in renal dx, ulcer dx, and aspirin hypersensitivity |
|
Definition
|
|
Term
| What Opiate Analgesics are used for migraines? |
|
Definition
Oxycodone, Hydromorphone, and Hydrocodone
OHH |
|
|
Term
| Opiate analgesics are (effective/ineffective), (cause/can't cause/prevent) rebound headaches, and (cause/can't cause) dependency. |
|
Definition
| effective, cause rebound HA, cause dependency |
|
|
Term
| The opioid analgesic _____ is used for migraine PTs not responding to other therapies |
|
Definition
|
|
Term
| _____ is an alternative to frequent Office and ED visits. |
|
Definition
|
|
Term
| Opiate analgesics are effective, but reserved for _________ |
|
Definition
| rescue after conventional therapies fail |
|
|
Term
| ______ are contraindicated in infrequent mod-severe HAs as well as conventional therapies |
|
Definition
|
|
Term
| What antiemetics are used with oral migraine meds? |
|
Definition
Metoclopramide and Prochlorperazine
(MetPro) |
|
|
Term
| antiemetics should be taken _____ before oral migraine meds. |
|
Definition
|
|
Term
| Which antiemetic improves gastroparesis and improves absorption from the GI tract? |
|
Definition
|
|
Term
| Which antiemetic is a DA antagonist, and is thus used for intractable HA monotherapy or refractory migraine? |
|
Definition
|
|
Term
| _____ are used as rescue meds for status migraines, which last _____. an example is____ |
|
Definition
| corticosteroids, more than one week, IV dexamethasone |
|
|
Term
| Which drug is a last resort and may cause recurrent HA? |
|
Definition
|
|
Term
| Which medications are migraine specific, nonselective 5HT1 agonists, and for moderate to severe migraine? |
|
Definition
|
|
Term
| _____ should not be used within 24 hours of triptans |
|
Definition
|
|
Term
| Which drugs have the most common SE of NV, as well as weakness and fatigue? |
|
Definition
|
|
Term
| _____ interact with 3A4 inhibitors, incl protease inhibitors, azoles, cimetidine, erythromycin. The result is an (increase/decrease) of levels |
|
Definition
| ergots; increase ergot levels |
|
|
Term
| Ergotamine Tartrate, which shows inconsistent efficacy, is administered with _____, is available in _____dosage forms. |
|
Definition
| with caffeine, available as PO, SL, rectal suppository |
|
|
Term
| Dihydroergotamine generally (does/does not) cause rebound HA. |
|
Definition
|
|
Term
| rebound HA occurs with ________ when the PT doesn't follow dosing |
|
Definition
|
|
Term
| Dihydroergotamine is available in _____ dosage forms |
|
Definition
|
|
Term
| ______ are first line for moderate-severe and rescue (in migraines) |
|
Definition
|
|
Term
| Which drugs are 5HT 1B/1D agonists |
|
Definition
|
|
Term
| Which drugs interact with MAOIs, SSRIs, SNRIs, and ergots? |
|
Definition
|
|
Term
| Which drugs are contraindicated in ischemic heart dx, uncontroled HTN, CVD, CAD and pregnancy? |
|
Definition
|
|
Term
| Which drug(s) has/have SEs of Chest tightness, flushing, local reactions, somnolence, fatigue, NV and dizziness? |
|
Definition
|
|
Term
| compared to sumatriptan, which drug shows better efficacy and consistency, and similar tolerability? |
|
Definition
|
|
Term
| Compared to sumatriptan, which drug shows better efficacy, similar consistency, but lower tolerability AND also interacts with potent 3A4 inhibitors? |
|
Definition
|
|
Term
| Which drug, when compared to sumatriptan, shows similar 2 hr efficacy, but is better in other results? |
|
Definition
|
|
Term
| Which triptan, which, despite its longest half life, shows lower efficacy compared to sumatriptan? |
|
Definition
|
|
Term
| Sumatriptan is available in what dosage forms? |
|
Definition
|
|
Term
| How do the second gen triptans differ from sumatriptan in terms of PK? |
|
Definition
| higher oral bioavailability and longer half-lives |
|
|
Term
| Due to accompanying GI effects, the oral absorption of _____ may be delayed ruing a migraine attack. |
|
Definition
|
|
Term
| ____are most widely used for migraine prophylaxis |
|
Definition
|
|
Term
| What are the FDA approved beta-antagonists for migraines? |
|
Definition
| propranolol and timolol (ProTim) |
|
|
Term
| more beta-selective forms of beta blockers are (more/less) effective |
|
Definition
|
|
Term
| Intrinsic sympathomimetic beta antagonists are (more/less/not) effective and include _____ |
|
Definition
| not; pindolol, acebutolol (PA, AcePin, etc) |
|
|
Term
| ____are useful in PTs with comorbid anxiety, HTN or angina |
|
Definition
|
|
Term
| What other, non-FDA b-blockers are used for migraines? |
|
Definition
| Nadolol, Atenolol, Metoprolol (NAM) |
|
|
Term
| Antidepressants are used for _______ |
|
Definition
|
|
Term
| the migraine effects of antidepressants are (proportional/inversely proportional/independent) relative to their antidepressant activity |
|
Definition
|
|
Term
| Most antidepressant data for migraines exists for _____. Its metabolite _____ is also used. |
|
Definition
| Amitriptyline; Nortriptyline |
|
|
Term
| What antidepressants are used for migraine prophylaxis based on clinical and anecdotal experience? |
|
Definition
| Other TCAs, SSRIs (esp prozac), and MAOIs in refractory cases. |
|
|
Term
| In migraine PTs with comorbid depression, anxiety or insomnia, _____ should be used. |
|
Definition
|
|
Term
| Anticonvulsants are used for ________ |
|
Definition
|
|
Term
| which medication class enhances GABA, modulates glutamate, and inhibits Ca and Na channels? |
|
Definition
|
|
Term
| What are the FDA approved anticonvulsants in migraine use? Which non-approved drug(s) is/are also used? |
|
Definition
| Valproate and Topiramate; Gabapentin |
|
|
Term
| If a migraine PT has comorbid seizures, anxiety or BPD, which drug class should be used? |
|
Definition
|
|
Term
|
Definition
| 2nd-3rd line migraine prophylaxis |
|
|
Term
| What CCBs are used for migraines? |
|
Definition
| Verapamil (modest and known?); also Nifedipine, Nimondipine, Nicardipine, Diltiazem |
|
|
Term
| What is considered last-line for migraine prophylaxis? |
|
Definition
|
|
Term
| What drug(s) is a/are potent 5HT2 antagonist(s) |
|
Definition
|
|
Term
| Which medication causes a rare retroperitoneal fibrosis if used long term, and thus requires a yearly cardiac workup? |
|
Definition
|
|
Term
| Which migraine prophylactic must be compounded? |
|
Definition
|
|
Term
| Which migraine medication(s) has/have SEs of GI intolerance, muscle aches, leg cramps, claudication, weight gain, and hallucinations? |
|
Definition
|
|
Term
| Which migraine medication(s) is/are contraindicated in Pregnancy, PVD, CAD, severe HTN, thrombophlebitis, cellulitis, PUD, liver/renal dysfunction and valvular heart dx? |
|
Definition
|
|
Term
| in migraines, NSAIDs are used for _____ and show (low effect/modest effect/great effect) |
|
Definition
|
|
Term
| Which drug(s) is/are best for intermittent prevention of predictable migraines? |
|
Definition
|
|
Term
| Which drug(s), when used long term for migraines, should be monitored for renal function and blood loss? |
|
Definition
|
|
Term
| In menstrual migraines, _____ should be started _____ before the HA onset and (discontinued before/continued through) the vulnerable period |
|
Definition
| NSAIDs, started 1-2 days before, continued thru |
|
|
Term
| Other migraine prophylactic agents include _____ |
|
Definition
| Riboflavin (B2), Botulinum toxin type A inj (localized), lisinopril, Candesartan, as well as Feverfew and Petasites |
|
|
Term
| Pharmacologic tx for tension headaches include ______ |
|
Definition
| analgesics (w or w/o caffeine) and NSAIDs: Aspirin, Ibuprofen, naproxen |
|
|
Term
| Tension headache medications for prophylaxis include______ and should be based on______ |
|
Definition
| TCAs (amitriptyline), Botulinum inj.; comorbidities |
|
|
Term
| 100% Oxygen is tx for _______ and should be inhaled for _____. |
|
Definition
|
|
Term
| IV/IM ___________ provides relief in 10 minutes and may be repeated for _______ to break the cluster cycle |
|
Definition
| dihydroergotamine; 3-7 days |
|
|
Term
| SQ/IN ________ is tx for cluster HAs and treatment may be given for _____ |
|
Definition
|
|
Term
| _____ is the preferred CCB in cluster headache prophylaxis |
|
Definition
|
|
Term
| ______ is effective against episodic and cluster attacks |
|
Definition
|
|
Term
| _____ can be used daily, alone or in combo with verapamil or Lithium for refractory cluster HA |
|
Definition
|
|
Term
| _____ is used when other cluster HA prophylaxis tx prove unresponsive |
|
Definition
|
|
Term
| _____are useful for inducing remission of Cluster headaches, BUT long term use should be avoided and the drug should be tapered over_____ |
|
Definition
|
|
Term
| Ergotamine Tartrate suppositories are dosed how? |
|
Definition
| It is given .5-1 suppository at onset and then 1 q1h prn |
|
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